Factors associated with quality of life among joint and nuclear families: a population-based study.

BACKGROUND: Advantages and disadvantages associated with joint and nuclear family systems can affect quality of life (QOL). However, there is scarcity of literature about QOL among joint and nuclear family systems. This study aimed to assess the factors associated with QOL in joint and nuclear family systems. METHODS: We conducted a population based cross sectional study in all 52 Union Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select participants from both nuclear and joint family houses. The validated Urdu version of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) was used to assess quality of life among participants. Univariate and multivariate analyses were performed to explore the associations of different socio demographic variables with QOL among both family systems. Also a multilevel linear regression using backward analysis to obtain final model for each domain was performed to find out the variables that are associated with QOL score in each of family systems. RESULTS: A total of 2063 participants were included in this study (51.0% joint family, 49.0% nuclear family) with the response rate of 97.4%. In multiple linear regression analysis of each domain for joint and nuclear family systems, rural residence compared to urban (p < 0.001), being female (p < 0.001), older age (p < 0.001), having comorbidity (p < 0.001) and lower socioeconomic status (p < 0.001) were found to be a strong predictor of poorer QOL. Furthermore, social capital (p < 0.001) had a positive effect on joint and nuclear family QOL scores. CONCLUSION: This study was the first of its kind which determined the factors of QOL in joint and nuclear families using the validated Urdu version of WHOQOL-BREF in Pakistan. Male gender, urban residence, younger age, higher socioeconomic status and social capital were positive predictors of QOL score while older age and presence of illness were associated with lower QOL scores among both family systems.

Treatment-related complications in patients with esophageal cancer: A systematic review and network meta-analysis.

BACKGROUND: The aim of this review was to compare the available treatments of esophageal cancer, in terms of pulmonary, cardiovascular complications, anastomotic leakage, and esophagitis after treatment in patients with esophageal squamous cell carcinoma (SCC). METHODS: Medline, Web of Science, Scopus, the Cochrane Library and Embase were searched. The randomized controlled trials (RCT) that had compared the treatment -related complications of treatments for esophageal SCC were included. We included 39 randomized control trials in a network meta-analysis. The Chi2-test was used to assess of heterogeneity. The loop-specific and design-by-treatment interaction methods were used for assessment of consistency assumption. The risk ratio with 95% confidence interval (CI) was used to report the effect-sizes in the network meta-analysis. RESULTS: The pulmonary complication, cardiac complication, anastomotic leakage, and esophagitis were reported in 31, 11, 17, and 15 RCTs respectively. Video-assisted thoracoscopy + laparoscopy (VATS) was rank as the first and second treatment in terms of lower risk for pulmonary complication and anastomotic leakage. There was no statistically significant difference between treatments in terms of lower risk of cardiovascular complications. However, Surgery + Cisplatin + Fluorouracil (SCF) was ranked as better treatment. 3-dimensional conformal radiotherapy + Docetaxel + Cisplatin (3DCRTDC) was the best treatment in terms of lower risk for esophagitis. CONCLUSION: According to the results of this study, it seems the risk of pulmonary, cardiovascular, anastomotic leakage and esophagitis complications for VATS, SCF, surgery + radiotherapy (SRT), and 3DCRTDC was lower than other treatments respectively in the networks.

Exploring spatial dependencies in the prevalence of childhood diarrhea in Mozambique using global and local measures of spatial autocorrelation.

Background: Diarrhea in children under 5 years is generally considered as an important public health problem and the major cause of childhood morbidity and mortality in Sub-Saharan Africa. The purpose of this study was to present exploratory spatial data analyses to identify spatial clusters and outliers in the prevalence of childhood diarrhea in Mozambique. Methods: Using data from 2011 Mozambique Demographic and Health Survey, we calculated the prevalence of childhood diarrhea on the district level. Two exploratory spatial data analyses methods were applied, namely, global and local Moran's I statistics, providing spatial autocorrelation and spatial clusters/outlier in the prevalence of childhood diarrhea, respectively. Results: Choropleth mapping and global Moran's I statistics showed that the prevalence of childhood diarrhea has clustered distribution across the study area. A local Moran's I index revealed spatial clusters within the province of Tete, Gaza, Cabo Delgado, and Zambezia. However, spatial outliers were confined within Sofala province. Conclusion: The exploratory spatial data analyses showed various spatial clustering and outliers present in the prevalence of childhood diarrhea, indicating interventions needed in targeted regions.

Spatio-temporal analysis of Pertussis using geographic information system among Iranian population during 2012-2018.

Background: In spite of existing vaccination programs in many countries, outbreaks of pertussis are still reported. In Iran, the suspected and confirmed cases of pertussis are reported annually. Due to the lack of similar studies, the purpose of the current study was to determine the Spatio-temporal distribution of Pertussis using Geographic Information System (GIS) to identify high-risk areas in Iran during 2012-2018. Methods: In the current cross-sectional study, registered data in the department of vaccine-preventable diseases in the Iranian ministry of health were used. To assess the temporal trend, the Cochran-Armitage test was used. To show the spatial distribution and to identify hotspot areas, Choropleth map and Getis-Ord Gi statistics were used. All analyses performed by Arc.map10.5, Stata 15 and Excel 2010. Results: The incidence of suspect pertussis cases had an increasing trend but did not have a linear trend (p=0.06). Most of the cases happened in under 1 year infants (62.66%). The incidence of reported cases in northern areas was higher than in the Southern areas. The Zanjan had the most reported cases during the understudied period with a median of 7.63 reported cases per 100,000. The clustering of infection and hotspots were identified in northern areas of Iran including Qazvin, Qom, Markazi, and Hamadan. Conclusion: Our results showed that the cumulative incidence of reported cases is increasing. The northern provinces had the highest incidence of Pertussis. Therefore, the causes of this spatio-temporal pattern of pertussis should be determined. Also, supervision on vaccination programs in high-risk areas is recommended.

Effect of maternal mental health during pregnancy on infant growth at six months of age in Suburban communities in South of Iran.

Background: Due to the controversial effects of mental health disorders during pregnancy on infant health, the present study aimed to evaluate the effect of gestational depression, stress, and anxiety on the growth of offspring at six months of age in disadvantaged communities in South of Iran. Methods: The sample comprised of 470 pregnant women (response rate=98%) who are participated in the Bandar Abbas Pregnancy Cohort study. Maternal mental health was measured by the DASS-21 questionnaire during pregnancy. Data on infant growth was collected based on infant`s growth chart at six months of age. The relative risk of suboptimal infant growth was calculated by Modified Poisson regression models at 5% significant level. Results: The prevalence of depression, anxiety, and stress was 19.0%, 26.1% and 6.5%, respectively. At six months of age, the mean (SD) of infant`s weight (gram), height (cm) and head circumference (cm) were 7287.30 (1019.85), 63.23 (5.62) and 41.39 (2.70), respectively. Compared to normal mothers, the risk of suboptimal weight at six months of age significantly increased by 71% in mothers who were classified as having depression (Adjusted RR: 1.71, 95% CI: 1.07, 2.09). The presence of anxiety significantly increased the risk of suboptimal height at six months of age by 43% (ARR: 1.43, 95% CI: 1.07, 1.92). There were no statistically significant effects of either depression anxiety or stress on the suboptimal head circumference at six months of age. Conclusion: Our results showed that mental health disorders of pregnant women might adversely influence the weight and height growth of offspring within the first six months of age. Screening protocols to early diagnose of mental health disorders during pregnancy, and to strict follow up of diagnosed cases postpartum are proposed.

Assessing the quality of life among Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF): a population based cross-sectional study.

BACKGROUND: Measuring quality of life (QOL) in a population is important for the predictions of health and social care needs. In Pakistan, health related quality of life data exist but there are no quality of life data of general population. In this study, quality of life was assessed among the Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF). METHODOLOGY: A population-based cross-sectional study was carried out in all 52 Union Councils of District Abbottabad, Khaber Pkutunkhua province, Pakistan from March 2015 to August 2015. Multi-stage cluster sampling technique was employed in this study. Quality of life was measured by using the validated WHOQOL-BREF instrument, along with socioeconomic, demographic, and World Bank social capital questions in this population- based study. The data were collected through households, utilizing face to face interviews. The association between socio-demographic variables and quality of life domains were determined by using both univariate and multivariate analysis. Descriptive statistics were derived, and a multilevel linear regression using backward analysis allowing to obtain final model for each domain was achieved to recognize the variables that affect quality of life score. RESULTS: A total of 2063 participants were included in this study (51.2% male, 48.2% female). Mean age of participants was 37.9, SD = 13.2; ranging from 18 to 90. Mean score of quality of life domains (physical, psychological, social relationship and environmental domains) were 65.0 (SD = 15.2), 67.4 (SD = 15.0), 72.0 (SD = 16.5), 55.5 (SD = 15.0), respectively. Overall, socioeconomic status was established to be the strongest predictor of poorer quality of life for all domains as a change in SES from high to low results in reduction about (ß = - 5.85, ß = - 9.03, ß = - 8.33, ß = - 9.98, p < 0.001). Similarly, type of residency was negatively associated with physical, psychological and environmental domains while age and sex were negatively associated with physical, psychological and relationship domains in final model. Furthermore social capital (ß = 0.09, ß = 0.13, ß =0.14, ß =0.15, p < 0.001) had a positive effect on Pakistani quality of life. Overall, subjective quality of life was found to be low in our population and extremely varied by socio-demographic variables. CONCLUSIONS: Increasing age, having average and lower socioeconomic status and living in the rural area were found to be the strong predictor of poorer quality of life in all domains, while total social capital score had a positive effect on Pakistani quality of life scores.

Knowledge, attitude, and practice among mothers about newborn care in Sindh, Pakistan.

BACKGROUND: Each year nearly 7.7 million children under five years die around the world; out of which approximately 3.1 million of the newborns die during the neonatal period and almost all these (99%) deaths occur in the developing countries. According to the World Health Organization's estimation neonatal deaths account for 45% of the under-five deaths. More than one-third of these deaths occur in the first 24 h of birth, whereas three-quarter of the neonatal deaths takes place in the first seven days of birth. The purpose of this study is to assess the knowledge, attitude, and practices (KAP) among mothers about newborns' care and its related factors in district Badin Sindh province of Pakistan. METHODS: A community-based cross-sectional study was conducted from July 2017 to August 2017 to assess the Knowledge, Attitude, and Practices (KAP) in mothers regarding newborn care. A structured questionnaire was administered, after pretest, for data gathering through face to face interview. All survey participants were identified using multi-stage cluster sampling. A scoring system was used to calculate the level of KAP among participants. Independent sample t-test, ANOVA, and GLM were applied to identify the statistical difference between the means of various groups. RESULT: A total of 518 survey participants were interviewed. Among the study sample, more than half of the newborns were bathed within six hours of delivery. Around 50% started breastfeeding after 1 h of birth. A substantial proportion (45%) of mothers gave pre-lacteal feeding and 44.8% of them did not feed colostrum to their newborns. Among those who administered pre-lacteal to their newborn babies included animal/formula milk (15.4%), honey (24.5%) and fresh butter/ghee (5.2. %). Mothers with no education had less significant KAP score about newborn care as compared to those who had higher education (p < 0.05). CONCLUSION: This study revealed that high-risk factors such as immediate bathing, application of traditional substances on the cord, delayed initiation of breastfeeding, discarding colostrum and giving pre-lacteal feed to newborns were highly prevalent. This requires urgent attention of Maternal, Newborn and Child Health (MNCH) programs and health care delivery system to prevent harmful care practices and adopt healthy practices especially in the rural settings.

The relationship between maternal mental health during pregnancy and type of delivery in the suburbs of Bandar Abbas during 2017-2018.

Background: The effect of maternal mental health during pregnancy on Cesarean section through implications of pre- and postnatal birth have narrowly been investigated. The aim of the present study was to investigate the effect of maternal mental health during pregnancy on the type of delivery in the suburbs of Bandar Abbas. Methods: This study used data of 200 mothers registered in a prospective cohort study on pregnant women in the suburbs of Bandar Abbas, South of Iran, during 2016-18. The presence of depression, anxiety, or stress in expecting mothers were measured by DASS-21 questionnaire and the outcome defined as having Cesarean section (Cesarean section) was measured at postpartum. The relative risk (95% CI) was calculated using Cox regression models. All analyses were performed using STATA statistical package, with a significance level of 5%. Results: Information of 196 mothers were collected (98% response rate); the mean age of the participants was 27.28 (±5.62) years. The prevalence of depression, anxiety, and stress was 13.8% (27), 40.4% (40), and 7.6% (15), respectively. Nearly 40% of mothers went through Cesarean section. Compared to mothers with good mental health, the risk of Cesarean section was 96% higher in depressed mothers (RR=2, 95% CI: 1.43-2.74) (p=0.001), 81% higher in anxious mothers (RR=1.81, 95% CI: 1.29-2.53) (p=0.003), and 75% higher in stressed mothers (RR=1.75, 95% CI: 0.86-3.56) (p=0.121). Conclusion: The findings of this study showed that poor mental health, especially anxiety and depression, during pregnancy could increase the risk of Cesarean section. Accordingly, screening protocols for mental health status and prenatal counseling sessions are suggested for pregnant mothers to increase their informed decision on types of delivery.

Level of satisfaction and its predictors among joint and nuclear family systems in District Abbottabad, Pakistan.

Background: Family system has been found to affect the satisfaction level among the family members. The objective of our study was to determine the satisfaction level and its predictors among joint and nuclear family systems in District Abbottabad, Pakistan. Methods: We conducted a population-based cross-sectional study in all 52 Union Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select 2063 participants from both nuclear and joint family houses. Proportionate sampling was done for selecting mohalla from each UCs, and then subsequently households from respective mohalla's. Simple random sampling was done for selecting the 18 years and above-aged participant for the study. A structured demographic questionnaire was used to collect information from study participants. Univariate and multivariate logistic regression analysis was done to find out the predictors of satisfaction level among joint and nuclear family systems using SPSS version 20 A p-value of <0.05 was considered as significant. Results: Level of satisfaction was found to be higher among people living in the joint family system i.e., 87.5 % v/s 81 % (<0.001) compared to the nuclear family system. Multivariate regression analysis of nuclear family system showed that people having higher education level and higher socioeconomic status (SES) were more satisfied as compared to no education & low SES respectively. While, in the joint family system, only high SES was a significant predictor of satisfaction in the joint family system as compared to low SES. Conclusion: Our study reported a high level of satisfaction among joint and nuclear family systems in Pakistan. High education level and high SES were identified as important predictors of satisfaction among both systems.

A Forensic Epidemiological Study of Homicide in Isfahan Province and Review of the Literature.

The epidemic of deaths by homicide affects every society around the world and represents a major public health crisis. Detailed information on the characteristics of homicides victims from Islamic countries is limited. This article presents forensic epidemiological data on homicides in Isfahan, Iran, during 2013-2015. Isfahan has a population of more than 5 million and 69,387 deaths with 246 homicides between 2013 and 2015. Most victims were male (73%), between the ages of 15 to 29 years (39.5%), married (54%), and employed (54%). The relationship between the actor and the victims showed that 12% were married, 15% friends, 25% strangers, and 47% others or unknown. The most frequent method of homicides was by stabbing (45%), followed by firearms (23%), strangulation (14%), and blunt force trauma (7%). The top 3 methods among males were stabbing, firearms, and strangulation, whereas among females, it was stabbing, strangulation, and by other methods. There was no significant effect on homicide rates by month, weekday, or temperature. Investigators examining deaths in Muslin countries must understand and adjust for the culture, norms, and religious ideology.

Psychometric properties of the Urdu version of the World Health Organization's quality of life questionnaire (WHOQOL-BREF).

Background: The present study was conducted to translate and validate the World Health Organization's Quality-of-Life Scale - BREF into local language of Pakistan. Methods: A forward- backward translation procedure was followed to develop the Pakistani version of the questionnaire. Through a multi- stage clustered sampling technique, a sample of individuals aged 18 years and above completed the questionnaire in Abbottabad district, Pakistan. Psychometric properties of the instrument including reliability (internal consistency and test-retest analysis), validity (known group comparison and items' correlation) and their domains were assessed. Satisfactory results were also shown in the correlation matrix in all domains. Results: A total of 2060 participants were recruited in this study. Participants' mean age was 35.51 (SD= 14.31) years in healthy individuals and 39.29 (SD= 14.31) years in diseased individuals. The internal consistency of the WHOQOL-BREF (Pakistani Version) was 0.86. Moreover, the physical, psychological, and environmental domains had acceptable reliability (alpha= 0.78, 0.75, and 0.73, respectively), but reliability was low (alpha= 0.56) in the social domain. Reproducibility of the WHOQOL-BREF was as follows: ICC range: 0.72-0.92 at 2-week retest interval. After performing comparison analysis, the results indicated that the questionnaire significantly segregated the study groups in all QoL domains, except for social relationship. Conclusion: The study provided strong exploratory evidence for the reliability and validity of the WHOQOL-BREF for use in Pakistan. However, more exploration is needed to improve the reliability results in the social domain.

Prevalence of depression in people with HIV and AIDS in Iran: A systematic review.

Background: Depression is the most common mental disorder in individuals with HIV and AIDS (PLWHA), and comorbidity with depression exacerbates the disease. Several studies have estimated the prevalence of depression in HIV and AIDS patients so far, but there is no consensus about the prevalence of depression among these patients. Thus, we aimed at estimating the overall prevalence of depression among Iranian PLWHA. Methods: The international and national databases including Web of Science, Scopus, Medline, Science Direct, MagIran, Scientific Information Database (SID), IranMedex, and Medlib were searched until June 2016. The quality of included studies was assessed using Newcastle-Ottawa Scale. Results: Out of 591 references, 9 cross-sectional studies met the eligibility criteria and were included in the review. The lowest and highest reported prevalence of depression among people with HIV was 22% (95% CI: (11, 33)) and 76% (95% CI: (71, 81)), respectively. Prevalence of depression in people with HIV in the north, west, and south of Iran was 45% (95% CI: (23, 67)), 30% (95% CI: (15, 45)), and 56% (95% CI: (35, 77)), respectively. Prevalence of depression among addict and non-addict patients was 25% (95% CI: (21, 30)) and 58% (95% CI: (40, 77)), respectively. Conclusion: According to the results of this systematic review, the prevalence of depression is considerable among Iranian PLWHA. Prevalence in the southern regions of Iran is more than the western and northern regions of Iran. This evidence may be useful for Iranian health policymakers to design suitable preventive and therapeutic interventions in PLWHA to prevent and control depression among these people in Iran.

Is the status of diabetes socioeconomic inequality changing in Kurdistan province, west of Iran? A comparison of two surveys.

BACKGROUND: About 80% of deaths in 350 million cases of diabetes in the world occur in low and middle income countries. The aim of this study was to determine the status of diabetes socioeconomic inequality and the share of determinants of inequalities in Kurdistan Province, West of Iran, using two surveys in 2005 and 2009. METHODS: Data were collected from non-communicable disease surveillance surveys in Kurdistan in 2005 and 2009. In this study, the socioeconomic status (SES) of the participants was determined based on the residential area and assets using principal component analysis statistical method. We used concentration index and logistic regression to determine inequality. Decomposition analysis was used to determine the share of each determinant of inequality. RESULTS: The prevalence of diabetes expressed by individuals changed from 0.9% (95% CI: 0.6-1.3) in 2005 to 3.1% (95% CI: 2-4) in 2009. Diabetes Concentration Index changed from -0.163 (95% CI: -0.301- -0.024) in 2005 to 0.273 (95% CI: 0.101-0.445) in 2009. The results of decomposition analysis revealed that in 2009, 67% of the inequality was due to low socioeconomic status and 16% to area of residence; i.e., living in rural areas. CONCLUSION: The prevalence of diabetes significantly increased, and the diabetes inequality shifted from the poor people to groups with better SES. Increased prevalence of diabetes among the high SES individuals may be due to their better responses to diabetes control and awareness programs or due to the type of services they were provided during these years.

Using drug sales data to evaluate the epidemiology of cardiometabolic risk factors and their inequality: an ecological study on atorvastatin and total cholesterol in Iran.

BACKGROUND: Statins have been effective medications in lowering serum total cholesterol (TC) concentrations across populations over time. The aim of this study was to estimate national and provincial trends in atorvastatin sales in Iran, to systematically quantify its relationship with socioeconomic indicators, and changes in TC level. METHODS: In this retrospective ecological study, conducted in Iran, we examined trends in atorvastatin sales, the wealth index (WI) as a validly-available socio-economic indicator, and TC level between 2004 and 2011. The main outcome variable was mean atorvastatin sold in defined daily dose per 100,000 people per day (DPD). We analyzed the relationship between WI and DPD and between DPD and mean TC across time and space. RESULTS: At national level, both mean WI and mean DPD showed increasing trend over time, while we observed decreasing trend for TC. Mean WI and DPD in 2011 was nearly 5 and 50 time that of their respective figures in 2004, while the mean TC decreased for nearly 10%. Increases in both WI and DPD had happened in every province, but with different patterns. The maximum and minimum changes in DPD versus WI were seen in Gilan and North Khorasan respectively. CONCLUSION: A striking increase occurred in the sales for atorvastatin in Iran from 2004-2012 in most provinces examined. The wealthier a province became, the more sales were seen for atorvastatin. TC optimistically decreased from 2005 to 2011 and its decrease was positively correlated with increasing sales for atorvastatin.

How within-city socioeconomic disparities affect life expectancy? Results of Urban HEART in Tehran, Iran.

BACKGROUND: There is substantial lack of knowledge about the role of socioeconomic status (SES) indicators on life expectancy (LE) within-cities, especially within mega-cities. We aimed to investigate the disparities of LE within city districts of Tehran, Iran, and specify how SES inequalities play role on LE. METHODS: The death and population data for 2010 by different age, gender, and residency district were obtained from the main cemetery of Tehran and statistical centre of Iran, respectively. Age-specific mortality rates and consequently LE were calculated for all 22 districts by different genders. Finally, based on the results of first Tehran's Urban Health Equity Assessment and Response Tool (Urban HEART) project in 2008, the influence of social classes (SCs), total costs, and education indicators were analyzed on LE at birth (e0). RESULTS: The e0 for total males and females in Tehran were calculated as 74.6 and 78.4 years for 2010, respectively. The maximum LE of 80 years was observed in females of northern part with higher SES, and the minimum e0 of 72.7 years observed in males of southern part with lower SES. The e0 gender gap among districts was 5.5 years for females and 3.7 years for males. The highest and lowest mean of e0 observed in SC1 (highest class) and SC5 (lowest class), were 77.6 and 76.0 years, respectively. The lowest mean of e0 observed in the first group of total costs indicator and was 76.2 years. In addition, the lowest observed mean of e0 was in the first category of education indicator (illiterate) and was 76.0 years. CONCLUSION: RESULTS indicate substantial disparities in LE within city districts. This confirms that SES disparities within-cities would have direct influences on LE.

Association of residential segregation and disability: a multilevel study using Iranian census data.

The association of racial segregation and health outcomes has been reviewed recently in the literature, but the health effect of other contexts of segregation with respect to residential environment has not as yet been fully reviewed. Besides, most of the literature on segregation has been performed in Western countries. Here, we undertake a multilevel analysis of residential segregation of socioeconomic and demographic factors and disability rate in an Eastern developing country in order to elucidate the effects of this aspect of segregation on disability rate. The latest Iranian national census in 2006 was used to measure segregation indices and perform the analysis. Information theory index and its ordinal form were applied to measure evenness dimension of segregation of categorical and ordinal variables, respectively. Segregation of contextual and structural characteristics of residential environment, which are important determinants of socioeconomic status in Iran, had different relations with disability rate. Provinces which were segregated by type of occupation of residents, sex, and ownership of a motorcycle had a lower individual disability rate, while age segregation and house ownership had a positive effect on the rate of individual disability in the province. The findings also showed that almost all the aforementioned segregation indices had the same effect on the rate of family disability. The unique contribution of this study is that it considers how segregation with respect to aspects of social characteristics other than race affects health outcomes. Further studies in this regard may reveal new insights into health outcome inequalities.

The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan.

INTRODUCTION: This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. METHOD: A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. RESULTS: A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). CONCLUSION: Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.

Network meta-analysis of palliative treatments in patients with esophageal cancer.

We aimed to compare available palliative treatments in terms of survival and to rank these treatments for esophageal cancer. Web of Science, Medline, Scopus, Cochrane Library and Embase were searched. The risk of bias was judged using Cochrane's tools. Statistical heterogeneity was assessed using the Chi2 test and was quantified by I2. The results were summarized using the hazard ratio (HR). The rank probability for each treatment was calculated using the p-score. Nineteen RCTs met the eligibility criteria for this study. Treatments formed three networks including networks A, B, and C. The Ultraflex stent (p-score = 0.93), irradiation stent (p-score = 0.89), and thermal ablative therapy (p-score = 0.85) were the first ranking treatments in networks A, B, and C, respectively. Based on the results of this network meta-analysis, it appears that the ultraflex stent, the irradiation stent, and thermal ablative therapy are the better treatments among the networks.

Estimating blood transfusion requirements in preparation for a major earthquake: the Tehran, Iran study.

INTRODUCTION: Tehran, Iran, with a population of approximately seven million people, is at a very high risk for a devastating earthquake. This study aims to estimate the number of units of blood required at the time of such an earthquake. METHODS: To assume the damage of an earthquake in Tehran, the researchers applied the Centre for Earthquake and Environmental Studies of Tehran/Japan International Cooperation Agency (CEST/JICA) fault-activation scenarios, and accordingly estimated the injury-to-death ratio (IDR), hospital admission rate (HAR), and blood transfusion rate (BTR). The data were based on Iran's major earthquakes during last two decades. The following values were considered for the analysis: (1) IDR = 1, 2, and 3; (2) HAR = 0.25 and 0.35; and (3) BTR = 0.05, 0.07, and 0.10. The American Association of Blood Banks' formula was adapted to calculate total required numbers of Type- O red blood cell (RBC) units. Calculations relied on the following assumptions: (1) no change in Tehran's vulnerability from CEST/JICA study time; (2) no functional damage to Tehran Blood Transfusion Post; and (3) standards of blood safety are secure during the disaster responses. Surge capacity was estimated based on the Bam earthquake experience. The maximum, optimum, and minimum blood deficits were calculated accordingly. RESULTS: No deficit was estimated in case of the Mosha fault activation and the optimum scenario of North Tehran fault. The maximum blood deficit was estimated from the activation of the Ray fault, requiring up to 107,293 and 95,127 units for the 0-24 hour and the 24-72 hour periods after the earthquake, respectively. The optimum deficit was estimated up to 46,824 and 16,528 units for 0-24 hour and 24-72 hour period after the earthquake, respectively. CONCLUSIONS: In most Tehran earthquake scenarios, a shortage of blood was estimated to surge the capacity of all blood transfusion posts around the country within first three days, as it might ask for a 2-8 times more than what the system had produced following the Bam earthquake.

Effect of Social Distancing on COVID-19 Incidence and Mortality in Iran Since February 20 to May 13, 2020: An Interrupted Time Series Analysis.

BACKGROUND AND OBJECTIVE: Numerous actions have been taken to control the COVID-19 pandemic and reduce their morbidity and mortality. One of the most important measures in this regard is social distancing. However, there is limited evidence on the effectiveness of social distancing on COVID-19 incidence and mortality. Thus, the current study aimed to assess the effectiveness of social distancing measures on the COVID-19 incidence and mortality in Iran. MATERIALS AND METHODS: In the current quasi-experimental study, we evaluated the daily incidence cases and the number of deaths of COVID-19 in Iran before and after the implementation of social distancing measures. The segmented regression model was used to analyze the data. We also performed the interrupted time series (ITS) analysis using Newey ordinary least squares (OLS) regression-based methods. RESULTS: After the implementation of social distancing, the trend of both daily new cases and deaths due to COVID-19 was decreasing [(ß = -1.70 (95% CI = [-2.30 - -1.10; P < 0.001])) and (ß = -0.07 (95% CI = [-0.10 - -0.05; P < 0.001], respectively))]. CONCLUSION: Social distancing along with other public health interventions could reduce the morbidity and mortality of COVID-19 to some degrees, and it seems to be crucial to control the pandemic.